Deep brain stimulation (DBS) of the subthalamic region is an effective treatment for the motor symptoms of advanced Parkinson's disease (PD). However, following surgery to implant the DBS system in the PD patient, a neurologist may be confronted with the difficult challenge of balancing the patient's drug treatment and stimulation treatment to maximize therapeutic benefit while minimizing adverse effects. Conventionally, this complex process is driven by clinical experience. Typical optimization attempts require navigating an extremely large and complex treatment parameter space. Additionally, DBS may be associated with side effects generated by the unwanted spread of stimulation to non-target regions. The spread may depend on the patient-specific location of an electrode in the brain. The relationship between DBS electrode locations and treatment outcomes is the subject of extensive study.
First generation clinical decision support systems (CDSS) that incorporate patient-specific imaging data and electrical stimulation models to help customize DBS parameter settings to the patient have been developed in the past decade. See, for example, McIntyre, C. C., Mori, S., Sherman, D. L., Thakor, N. V, Vitek, J. L.: Electric field and stimulating influence generated by deep brain stimulation of the subthalamic nucleus. Clin Neurophysiol. 115, 589-95 (2004), Butson, C. R., Cooper, S. E., Henderson, J. M., McIntyre, C. C.: Patient-specific analysis of the volume of tissue activated during deep brain stimulation. Neuroimage. 34, 661-70 (2007), and Frankemolle, A. M. M., Wu, J., Noecker, A. M., Voelcker-Rehage, C., Ho, J. C., Vitek, J. L., McIntyre, C. C., Alberts, J. L.: Reversing cognitive-motor impairments in Parkinson's disease patients using a computational modelling approach to deep brain stimulation programming. Brain. 133, 746-61 (2010). These first generation commercial DBS CDSS include, for example, Optivise by Medtronic (MN, USA) or GUIDE by Boston Scientific (MA, USA)). While these conventional CDSS systems provide guidance regarding electrical stimulation for postoperative PD patients, they ignore the pharmacology side of patient management.